All Tattoo Technician Applicants Must Provide the Following:
Source: www.amherstma.gov
Topic: Tattoo
Sort Desciption: Application for Tattoo Technician License. Tattoo Technician - ANNUAL FEE $250.00 ... All Tattoo Technician Applicants Must Provide the Following: ...
Content Inside: AMHERST HEALTH DEPARTMENT 70 BOLTWOOD WALK • AMHERST • MA • 01002 Office (413) 259-3077 Fax (413) 259-2404 Environmental Health Division (413) 259-3078 www.amherstma.gov _________________________________________ Application for Tattoo Technician License Tattoo Technician - ANNUAL FEE $250.00 Date: _______________________________________ DOB ___________________________ Name: ______________________________________ Tel. # ___________________________ Address: ______________________________________________________________________ (#, street, city/town, state, zip code, P. O. Box) Business Name: ______________________________ Tel. # ___________________________ Business Address: ______________________________________________________________ (#, street, city/town, state, zip code, P. O. Box) All Tattoo Technician Applicants Must Provide the Following: [ ] Driver’s License, Passport or other photographic proof of identity and age. [ ] High School Diploma or its equivalent. [ ] Evidence of course completion in Preventing Disease Transmission (American Red Cross or its equivalent). [ ] Evidence of current certification (within last 2 years) in First Aid and CPR (American Red Cross or its equivalent ) [ ] Proof of completion of a course in Skin Diseases, Disorders and Conditions. (American Red Cross or its equivalent.) [ ] Proof of one year licensing as a tattooist, or three (3) years apprenticeship training under a qualified tattooist from another state or municipality. Have you ever had a license from another state or locality suspended or revoked? Yes No I, certify, under the pains and penalties of perjury, that the information provided to the Board of Health is correct. I have received a copy of the Regulations for Body Art. I agree to abide by all terms and conditions set forth by the Board of Health. ____________________________________________ _________________________ Signature of Applicant Date Signed Please Note The Following Late Fees Will ...
